In Canada, our single-payer system doesn't apply to prescription drugs outside hospital. There is a government plan for people on disability/welfare/folks > 65 y.o. What I would suggest for the USian single-payer plan, that Obama's going to implement any day now, with the help of his Tea Party friends:
- Do have copays. If everything is free, everybody runs to the dr for every tiny little thing, which drives up costs at that end.
- Have an EVIDENCE-BASED formulary. We've had situations where drug companies are making secret backroom deals with political appointeees that have no medical/pharmaceutical training (who make a salary several times' that of health care workers, natch) who have the final say over the recommendations of the expert committees (which consist of PharmDs and PhDs who get paid much less than their political overlords. But I digress).
- Don't have tiered co-pays. That's just confusing for everybody and is an extra hassle/expense. Have a flat co-pay. And have a mechanism for which unlisted drugs may be covered if the dr certifies that the patient meets certain criteria; ie, paying for Oxycontin only after the patient has been tried, and failed tx with, SR morphine.
- Have strict and specific criteria for how mixtures are paid for. We had a situation in Ontario where any mixtures were covered, so drs were ordering stuff like, Cepacol mouthwash 350mL, add 2 mL glycerin, for their mum who's too cheap to buy mouthwash. Similar scammery with the skin creams.
And there needs to be some thought about what OTCs are covered, and how. You don't want pts running to their dr to get rxs for Maalox and Gaviscon and Metamucil and sunscreen and bisacodyl etc (we used to get whole families on welfare who would basically spend their Saturdays taking the whole family to the dr to stock up the medicine cabinet), but you may want to cover, say, 80mg aspirin for your post-ACS pts.
